Work

"I do not see the point of using the system". Understanding a Broken Policy Knot in the Primary Care Sector

Year: 2025

Type: article

Abstract: This paper explores the implementation of a policy promoting new cooperative practices in the primary care sector. Through a two-year multi-sited ethnographic study of Multi-Professional Healthcare Centers (MPHCs) and their coordination mechanisms, we highlight the gaps between the coordinative protocols that prescribe how these structures operate, and the certified Health Information System (HIS) that has been defined by public authorities to support the new practices. These gaps make us say that the policy knot - that entangles policy, practice, and design - broke. To understand why, we studied the biography of the certified HIS and identified that it is based on the practice of general medicine only. Without simply concluding that public policy has failed because of the system's shortcomings, we reveal the human effort involved in compensating for the HIS's inability to support the articulation work required for multi-professional coordination. Based on this empirical contribution, we offer the policy-oriented technological frame as a concept to make sense of IT in public health, and the congruence loop as a guideline to avoid the breakage of a policy knot.

Source: Proceedings of the ACM on Human-Computer Interaction

DOI: 10.1145/3711003

Authors: Manon Plegat, Myriam Lewkowicz

Institutions: Université de Technologie de Troyes, Université Paris 8

Language: English

Topic: Information Systems Theories and Implementation

Subfield: Sociology and Political Science

Field: Social Sciences

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: bronze

Funder: Agence Nationale de la Recherche